World Neurosurg
-
Case Reports
Enhanced safety of pedicle subtraction osteotomy reduction using intraoperative ultrasound.
Pedicle subtraction osteotomy (PSO) can improve sagittal alignment but carries risks, including iatrogenic spinal cord and nerve root injury. Critically, during the reduction phase of the technique, medullary kinking or neural element compression can lead to neurologic deficits. ⋯ We propose that intraoperative ultrasound is a useful supplement to standard neuromonitoring modalities for ensuring safe PSO reduction and decompression of neural elements.
-
Flexible stabilization has been utilized to maintain spinal mobility in patients with early-stage lumbar spinal stenosis (LSS). Previous literature has not yet established any nonfusion solution as a viable treatment option for patients with severe posterior degeneration of the lumbar spine. This feasibility study evaluates the mean 5-year outcomes of patients treated with the Total Posterior Spine System (TOPS) facet replacement system in the surgical management of lumbar spinal stenosis and degenerative spondylolisthesis. ⋯ The TOPS implant maintains clinical improvement and motion in the surgical management of LSS and spondylolisthesis, suggesting that it can be considered an option for these indications.
-
We assessed the sequential magnetic resonance imaging changes of indirect neural decompression after minimally invasive lumbar lateral interbody fusion (LIF) combined with posterior percutaneous pedicle screw (PPS) fixation for degenerative spondylolisthesis (DS) according to the severity of preoperative lumbar spinal stenosis. ⋯ Sequential enlargement of the spinal canal was obtained by the thinning of the ligamentum flavum after LIF and PPS fixation in patients with DS with both mild and severe stenosis. The effect of indirect neural decompression was equivalent even in those with severe lumbar spinal stenosis.
-
The lumbar spine displays its greatest mobility in ventral flexion, which is a potential risk factor for low back pain. The relative contribution of each segment to the complete flexion is denoted the spine rhythm, which is required to distinguish between normal and abnormal spinal profiles, and as well to calculate the spinal forces in musculoskeletal models. Nevertheless, different spine rhythms have been reported in literature and the effect of arm position has not been demonstrated. We therefore aimed to investigate the effects of different arm positions on spine rhythm during ventral flexion. ⋯ The lumbar spine displayed greater flexion in the middle and lower levels and its flexion rhythm remained unchanged at different arm positions. These results strike importance to explore for more reasons explaining the different lumbar flexion rhythms reported in literature.
-
Review
Paving the path to wellness: a systematic review of wellness programs for neurosurgery trainees.
Neurosurgical trainees have a heavy workload and poor quality of life, resulting in high rates of burnout and attrition. Consequently, wellness programs have been used by various training institutions to combat this situation. ⋯ There is a paucity of literature regarding trainee wellness in neurosurgery. A few training programs have instituted wellness initiatives for trainees, and the feedback was generally positive. However, objective measures of efficacy such as validated questionnaires and scales yielded mixed results.